Sustainability and transformation plans in London

Sustainability and transformation plans in London: an independent analysis of the October 2016 STPs | The Kings Fund | Nuffield Trust

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This report looks at the five Sustainability and Transformation Plans in London, their contents and common themes.  The authors, from The King’s Fund and the Nuffield Trust, assess the main issues and risks to be addressed across the plans. They make a small number of recommendations for the future of the STP process in London, focusing specifically on the role of London-wide action in taking forward the plans.  The report includes a brief update on progress since March 2017.

Download the full report here

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Understanding the NHS deficit and why it won’t go away

This briefing assesses the financial health of those providers by unpicking the headline figures presented in the official accounts to reveal the true underlying state of the NHS’s finances today, and to outline prospects for the next three to four years | Nuffield Trust

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Image source: Nuffield Trust

  • NHS trusts have begun the current financial year, 2017/18, on course for an underlying overspend or deficit of £5.9 billion. To meet their reported deficit target of £500 million, they will need to cut their operating costs by £3.6 billion and receive temporary extra funds of £1.8 billion.
  • This would require trusts to make savings in one year equivalent to 4.3 per cent of their operating costs – far in excess of any level achieved over recent years and likely to be almost impossible to deliver.
  • A more likely scenario is that they will make cost savings similar to the level made last year. That would collectively leave the trusts with an underlying deficit of around £3.5 billion.
  • The headline deficit for 2016/17 (which ended in March 2017) was £791 million. However, that figure was flattered by billions of pounds’ worth of one-off savings, temporary extra funding and accountancy changes that did nothing to improve the underlying state of provider finances. Once they are removed, the underlying deficit for 2016/17 is £3.7 billion.
  • This is compared to an underlying deficit the year before, 2015/16, of £4.3 billion. As trusts also had to soak up additional inflation costs in 2016/17, the reduction in the underlying deficit between 2015/16 and 2016/17 actually represents providers making £2.3 billion in permanent savings.
  • Projections of future years suggest that, even under optimistic assumptions for inflation and continued high levels of savings, NHS providers will continue to run a large collective underlying deficit until at least 2020/21.

Read the full briefing here

What’s behind delayed transfers of care?

Why are we waiting? The causes of DTOCs | By Nigel Edwards for the Nuffield Trust

As the data shows, the NHS had remained responsible for the majority of DTOCs over time, but the proportion for which social care are responsible has grown by 84 per cent since December 2010.

The data also allows us to explore the reasons for delays. The most significant change since November 2010 has been an increase in the number of days delayed due to patients waiting for a care package to be available either at home (172 per cent increase) or in a nursing home (110 per cent).

While the reduced availability of social care is often highlighted as the cause of DTOCs, 57 per cent of the delays occurred because of issues in the NHS.

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Read the full briefing here

Brexit means… an uncertain future for the NHS?

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Both Brexit and the new government under Theresa May have major implications for the NHS. The health service is already facing financial turmoil and chronic staff shortages – both thrown into further uncertainty by the UK’s departure from the EU. But with political attention dominated by Brexit negotiations, will the service get the help it needs? Nigel Edwards sets out the challenges ahead in his latest Nuffield Trust blog .

Care quality measures

The Health Foundation and Nuffield Trust have published Quality at a cost: QualityWatch annual statement 2016.

This report looks at a range of care quality measures across the NHS in England. It highlights several areas of health care where standards have improved, but the authors point to slowing improvement in other areas, growing waiting times and continuing financial pressures.

QualityWatch routinely monitors over 300 indicators spread across all domains of quality. This report considers a selection of areas from within this set, covering different stages of a patient’s experience of the health service, to give a picture of quality in 2016.

It looks across six main areas:

  • Public health
  • Primary care
  • Ambulances
  • Hospital care
  • Mental health
  • Condition-specific care (stroke and hip fracture)

The report observes that the pressure of austerity did not impact on quality measures straight away, but took a few years to be felt. Authors conclude that further ‘delayed decline’ could occur in other aspects of care quality, such as effectiveness of treatment or patient safety, given the extent of the challenges faced and ongoing austerity in health and social care spending.

Managing doctors, doctors managing

Good working relationships between doctors and managers are critical for the safety and quality of NHS care. Yet recent reports have referred to a ‘gulf’ between the two groups | Nuffield Trust

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Image source: Nuffield Trust

This research uses a detailed survey of doctors and managers at board and middle-management levels of NHS acute trusts, along with interviews and a focus group, to understand their views on the current state of the doctor–manager relationship in the UK, the pressures it is coming under, how it has changed, and the outlook for the future. Looking back on a survey from 2002 by the same authors, which identified similar themes, allows the research to examine what has changed over a decade of political turmoil, what has not, and where policy-makers and NHS leaders might look to improve the pivotal relationship between doctors and managers in future

Read the full report here

The Autumn Statement: Joint statement on health and social care

The King’s Fund, Nuffield Trust and The Health Foundation are urging the government to address the critical state of social care in its forthcoming Autumn Statement.

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Image source: The King’s Fund

The briefing calls on the government to recognise the immediate funding pressures facing the sector by bringing forward to next year funding from the Better Care Fund which is planned to reach £1.5 billion in 2019/20. It also makes it clear that the NHS funding settlement will need to be revisited in future financial statements.

Key messages

  • Total health spending in England will rise by £4.2 billion in real terms between 2015/16 and 2020/21. This will result in a real-terms increase of on average 1.1 per cent a year over this parliament.
  • Real-terms funding increases of 0 per cent in 2018/19 and 0.3 per cent in 2019/20 will not be enough to maintain standards of care, meet rising demand from patients and deliver the transformation in services outlined in the NHS five year forward view.
  • Public health spending will fall by at least £600 million in real terms by 2020/21, on top of £200 million cut from the budget in 2015/16.
  • While there are significant opportunities to improve productivity in the NHS, the pace of change required to deliver £22 billion of savings by 2020/21 is unrealistic. New inflationary pressures are also emerging that will increase costs and make pay restraint harder to sustain.
  • The number of people aged over 65 accessing publicly funded social care has fallen by at least 26 per cent over the past six years.
  • Even if the vast majority of councils choose to levy the new precept on Council Tax as they did this year, the publicly funded social care system faces a £1.9 billion funding gap next year.
  • UK public spending on social care is set to fall back to less than 1 per cent of GDP by the end of this parliament, leaving thousands more older and disabled people without access to services.

Read the full report here